Seanad Éireann - Volume 195 - 10 June, 2009
Nursing Homes Support Scheme Bill 2008: Second Stage (Resumed).
Question again proposed: “That the Bill be now read a Second Time.”
Deputy Áine Brady Deputy Áine Brady
Deputy Áine Brady: I thank Senators for their participation in this debate. As mentioned at the outset, the purpose of the Bill is to establish a new scheme that will equalise State support for public and private nursing home residents, ensure long-term care is affordable and anxiety free and that no one must sell his or her home during their lifetime to pay for their care.
The Bill addresses the reality that two thirds of all nursing home beds are in the private sector and puts in place for the first time a uniform system of financial support for individuals in public and private nursing home beds. We have worked hard to ensure this system contains strong safeguards, not only for the care recipient but also for his or her spouse or partner.
The new nursing homes support scheme, however, is only one component of the overall Government commitment to ensuring access to quality nursing home care for all who need it. While the new scheme addresses the issues of access and affordability, the new draft standards will address the fundamental issue of quality and safety.
A core principle of the health service reform programme is to put the users of health and personal social services at the centre of the services. We must ensure the protection of residents, safeguard and promote their health, welfare and quality of life, and ensure there is a focus on the dignity and autonomy of older people. These are the core objectives behind the draft national quality standards for residential care settings that were launched formally by the Minister on 9 March. Regulations will be required to underpin the standards. They are being drafted at present and are at an advanced stage. It is intended to have the relevant parts of the Health Act 2007 commenced on 1 July 2009 to allow the chief inspector inspect all centres against the regulations governing these centres, together with these approved standards.
As is evident, this is a time of great change within the nursing home sector. This year, for the first time, there will be a single comprehensive system of registration and inspection for all nursing homes, public, private and voluntary, and a single comprehensive system of financial support covering all nursing homes, public, private and voluntary. Moreover, both systems have the nursing home resident firmly at the heart of their service.
This is a time of great change within our population. Life expectancy in Ireland is increasing. This longevity is something to be celebrated, but it also presents policy challenges we must recognise. The latest statistics tell us that today 11% of people living in Ireland are aged 65 years or over. It has been estimated that this figure will rise to 20% by 2036, and to 29% by 2056. Thus, over the years ahead, our nation’s age profile will change. It is now, while our nation is still young, that we must consider the long-term care services needed to support us over the next half century and the funding model that, by virtue of financial sustainability, might ensure the long-term provision of such supports.
The fair deal represents a response to the immediate situation faced by private nursing home residents. However, the Government is also committed to further analysis to identify a financially sustainable funding model which will support the future infrastructure of all long-term care services, both community and residential. This work is critical to all our futures, both as the recipients of care services and as taxpayers.
I will address some of the specific issues raised by Senators. The care needs assessment allows for social, family and community support to be considered in addition to medical factors. It will not encompass arbitrary levels of dependancy, such as moderate dependancy or high dependancy; rather, it will examine whether a person needs long-term residential care. The assessment is holistic in nature. In addition to addressing medical needs, it provides for a person’s family and community supports to be taken into account, thus allowing for social factors to be considered. For example, a person who may once have been classed as being of medium dependancy but who lives in an isolated area may be assessed as requiring long-term residential care.
Concerns were expressed over the absence of any ceiling on contributions from those with farms or business assets. I am happy to confirm that an important measure was introduced on Report Stage in the Dáil that addresses this concern. The measure provides that the three-year cap will apply to farms and relevant businesses in certain specified circumstances. These include circumstances where the person has suffered a sudden illness or disability that caused him or her to require long-term residential care, the person or their partner was involved in running the farm or business until the time of the illness or disability, or a family successor certifies that he or she will continue running the farm or business.
Some concerns were expressed regarding the changes in asset values and how these changes might affect applicants under the scheme. A person can seek a financial review under the scheme and this can take account of changes in income or in the value of a person’s assets.
Senator O’Toole asked about the definition of “first three years” in regard to those already in care. The three-year period relates to the time a person has spent in a nursing home. As such, a person who has already been in a nursing home for three years prior to the introduction of the scheme will benefit from the three-year cap and will not have the principal residence taken into account. The only qualification is that the nursing home must be an approved institution that is registered, tax compliant and honouring the price agreement with the National Treatment Purchase Fund.
The care representative must be a specified relative or a fit and proper person approved by the court. This should address potential conflicts of interest that would arise if a health care professional were appointed as a care representative. The court would have to be satisfied the person is a fit and proper person, will act in the best interest of the applicant and does not have a conflict of interest.
Many Senators raised the issue of support for community-based services, bearing in mind that this Bill provides support for residential services. The Government is committed to community-based supports for older people and has allocated an additional €200 million towards the provision of community-based services over the past three years. The Government is committed to continuing to emphasise community-based care.
With regard to the benchmark on dependency, which I have already addressed, there is no level of dependency or cut-off point at which a person will fail to qualify under the care needs assessment.
The date on which the legislation will come into force will depend on the Bill’s passage through the House and on the conclusion of the agreements between the National Treatment Purchase Fund and the private nursing homes. A definite date cannot be agreed as yet but it is intended to have the scheme operational in the last quarter of the year.
With regard to Senator McFadden’s question on siblings, section 20 refers to the further deferral of the repayment of the ancillary State support in the case of the principal private residence. Those who can avail of this deferral include certain relatives termed “connected persons”. The siblings must satisfy certain conditions: the asset in question must be their only residence, they must have lived there for not less than three years preceding the original application for ancillary State support, and they must not have an interest in any other property.
Many Senators, especially Senator Twomey, referred to the future provision of public nursing home care. The Government is committed to continuing with the public provision of nursing home care. There are approximately 8,000 public long-stay beds. The Government is providing an additional 860 new beds under the fast-track initiative. We must acknowledge that most of the public capacity is old and the new standards and regulations are being introduced on 1 July this year. The HSE will audit the current facilities and plan to refurbish those that do not meet modern standards. Senators will agree that we should have both public and private facilities of the same standard.
Some Senators referred to the general strategy pertaining to older people and carers. My office is working on the national positive ageing strategy. We hope to proceed to public consultation shortly.
I thank Senators for their contributions. I look forward to the further Stages of this Bill when the views the Senators have put forward will be considered in detail. I commend the Bill to the House.
The Seanad divided: Tá, 29; Níl, 12.
An Cathaoirleach An Cathaoirleach
An Cathaoirleach: When is it proposed to take Committee Stage?
Senator Donie Cassidy Senator Donie Cassidy
 Senator Donie Cassidy: Next Tuesday.
Committee Stage ordered for Tuesday, 16 June 2009.
Sitting suspended at 5.25 p.m. and resumed at 6 p.m.
Seanad Éireann 195 Nursing Homes Support Scheme Bill 2008: Second Stage (Resumed).